CDC covid testing guidance goes from haphazard to ass-backwards
==============
Earlier this week, the CDC revised its guidelines for covid testing.
For background, the CDC categorized people into “five populations” for which COVID-19 testing may be appropriate:
- Individuals with signs or symptoms consistent with COVID-19 (“aka “symptomatics”)
- Asymptomatic individuals with recent known or suspected exposure to COVID-19 (e.g. in close contact for more than 15 minutes with an infected person; living in a high COVID-19 transmission area; having attended a public or private gathering of more than 10 people (without widespread mask wearing or physical distancing)
- Asymptomatic individuals without known or suspected exposure in special settings (e.g. frontline medical personnel and nursing home caregivers)
- Individuals being tested to determine resolution of infection (e.g. to establish a safe return to work after a prior positive test)
- Individuals being tested for purposes of public health surveillance (e.g. to determine the prevalence of COVID-19 in a targeted locale such as an apparent hot spot city or campus)
The CDC previously recommended testing for people in categories in the first 3 categories.
Here’s the big change to the CDC guidance … and why it’s wacky.
=============
The Change
In essence, the revised CDC guidance loosens the guidelines for category 2 — the exposed asymptomatics.
Now, the CDC says:
If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms:
You do not necessarily need a test unless you are a vulnerable individual or are prescribed to do so by your health care provider or State or local public health officials.
=============
The Rationale
The CDC doesn’t really provide a rationale, so pundits are going hog wild:
- Avoiding false sense of security: This is the only explicit acknowledgement that the CDC has made. The argument: testing negative is only operative for a day or so. Asymptomatics who test negative potentially increase community spread by pocketing their masks and stop practicing social distancing. Note: This is probably true, but isn’t new news, so shouldn’t be a decision-driver at this time.
- Speeding test results: The recent quantum level increases in testing have clogged analysis labs and stretched turnaround times to the point that results come too late for therapeutic relevance.
- Playing politics: The MSM and Dem governors (e.g. Cuomo) assert that the move was orchestrated by the White House simply as a political maneuver aimed at artificially suppressing the count of confirmed cases. Note: The political impact is equivocal since there will be a certain rise in the positivity rate — the metric that Dr. Birx says is the key number she watches to determine whether the economy and schools should be re-opened.
My hunch: all 3 factors probably motivated the change which obscures a bigger issue….
==============
Who to test?
Loyal readers know that I’ve questioned the CDC’s testing priorities from the get-go.
My view…
Testing people with COVID-19 symptoms is a waste of resources, especially when results take a couple of days.
For the most part, docs treat patients with flu / COVID symptoms the same way whether they test positive or not: severe symptomatics get hospitalized; mildly symptomatics get sent home and told to self-quarantine.
IMHO, the pay dirt is frequently testing targeted groups of asymptomatics (not those semi-randomly volunteering for tests) to determine the prevalence of COVID in their local communities (i.e. quickly identify hot spots) … and, frequently testing at point-of-entry to keep unknowing infectees from penetrating relatively safe “bubbles”(e.g. daily testing of all students before they enter a classroom or all employees and visitors before they enter a workplace).
The new Abbott $5, 5-minute test is a move in the right direction .. if only they could get it down to less than $1 and less than 1-minute … then we’d have a testing program that is really actionable.
==============
For more detail, see our prior posts: If test kits are scarce, let’s test the right people! and Let’s make COVID testing actionable
==============
Update:
The CDC has already backtracked and “clarified” the guidance gave earlier in the week.
CDC Director Robert Redfield now says, “Everyone who needs a COVID-19 test, can get a test, but everyone who wants a test does not necessarily need a test.”
What Redfield should have added is: While vast numbers of people can be tested, the analysis labs are backlogged, causing delays in results’ reporting … which, in many cases, renders the tests therapeutically worthless.
My routine observation: It’s hard to follow the science if scientists don’t agree … and if the science is unsettled (i.e. constantly changing — both directionally and specifically).
For more details, USA Today has a relatively balanced recap.
The Homa Files 
Leave a Reply